Growth plate fractures, also known as Salter Harris type fractures, are a common cause of lameness seen in young dogs (under 8-12 months of age). The growth plate is a soft area of the bone that is responsible for the increase in the length and formation of bones. Since they are softer spots of the bone they are weaker then the remaining areas and can lead to fractures. Common places include the femoral head (ball of the hip joint), distal femur (above the knee joint), tibial tuberosity (front of the shin bone) and within the distal humerus (above the elbow). Surgery is typically recommended as the primary treatment option since these fractures are usually associated with the joints and can lead to angular deformities or chronic limping if they do not heal properly. The hope is that with surgery the fracture is repaired and some portion of the growth plate continues working, which allows for continued growth.

Last Friday Dr. Schlicksup saw two cases of tibial tuberosity growth plate fractures in a young Yorkie, Prada, and a young mixed breed, Guinness. In this specific type of fracture the patellar ligament (attached to the kneecap and quadriceps muscles) pull the tibial tuberosity (front of the shin bone) loose. In most cases it does not completely break free and instead only partially pulls loose. X-rays show an image of the normal growth plate at the front of Prada’s shin bone (figure 1) and the fractured growth plate in her and Guinness (figure 2 and 3). Surgery is performed to prevent the piece from breaking free completely, because once the tuberosity lifts up, it allows the kneecap to ride higher then normal and can lead to kneecap (patella) luxations. Both cases had surgery early Friday morning. The procedure takes a little over an hour and the fracture is repaired using stainless steel pins and wires (Figure 4) to form a tension band apparatus. Both Prada and Guinness recovered in ICU that night and were discharged early Saturday morning. Recovery is usually around one month at home and most dogs return to full function after the recovery. We wish both of them good luck in their recovery and we will see them in 2 weeks to remove the staples and in one month for follow-up x-rays.

Mandy is a 12yo FS Rat Terrier. I began seeing Mandy in April of this year in Myrtle Beach. She had previously been diagnosed with a protein losing nephropathy. This is a disease in which the kidneys are letting protein leak out into the urine. Mandy was in renal failure and was on several medications and supplements to try and protect her kidneys and improve her kidney function. At the time that I saw her, she was acutely unable to walk in all 4 legs and was severely anemic (low red blood cell count). Her inability to walk was felt to be related to a stroke or disk disease in her neck. A lot of people would consider saying good bye at this point due to her inability to walk, chronic kidney failure, and need for a blood transfusion, but not Mandy’s mom and not Mandy. Mandy is a fighter and so is her mom. We brought Mandy home with us from Myrtle Beach and hospitalized her in Mt. Pleasant. She was given a blood transfusion and we continued to treat her supportively for suspected intestinal blood loss secondary to her kidney disease. She responded to treatment and even though she still was not able to walk, she was sent home where her mom continued to perform physical therapy. Seventeen days later, Mandy is now walking (although still wobbly) and is doing great!

It’s hard to believe that summer is right around the corner! With the weather heating up, we all need to be more conscious about keeping out pets cool. In preparation for the hot summer months, we’ve provided a short overview of heat stroke. This will prepare you for signs to look for and things you can do to help your pet if you think he/she may be suffering from this condition.

Heat stroke is an acute, progressive, life threatening emergency characterized by a core body temperature of >106*F. It causes multi-organ dysfunction including changes in the nervous, cardiovascular, respiratory, gastrointestinal, urinary and integumentary systems. Heat stroke can occur quickly and the disease state can progress rapidly. It is extremely important to seek immediate medical care!

Signs to look for:

Excessive panting, drooling

Wobbly, drunken, or abnormal gait

Weakness or collapse

Bloody or tarry stool

Depression, decreased responsiveness, seizures

What to do:

Quickly remove your pet from the environment where the over-heating occurred into a shaded/cool place

Begin cooling efforts! Place cool wet towels or tap water along the back of the neck, in the armpits, and in the groin region. You may also wet the ear flaps and paws with cool water. Directing a fan over these wetted areas will help to speed evaporative cooling.

Transport to the closest veterinary facility immediately!

Cooling your pet too aggressively or overcooling can also have significant adverse affects. Below are some guidelines to help prevent overcooling of your pet.

What not to do:

Do not use cold water, ice, or ice baths for cooling

Do not attempt to force water into your pet’s mouth, but you may have fresh cool water ready to offer should your pet be alert and show an interest in drinking.

Do not leave your pet unattended

Keeping pets indoors during peak hours is ideal. For pets kept outside, please be sure to provide cool, shaded areas and free access to water at all times. Never, ever leave pets in cars – even if the windows are open, temperatures inside the vehicle can climb rapidly. We hope you and your pets enjoy a safe and happy summer season!

While working emergency shifts over the years it is always concerning to hear that a pet may be choking. There are many conditions that can lead to symptoms that are described as choking. Some of these conditions can become life threatening very quickly while in other cases the symptoms may seem very dramatic with little or no danger to the pet. I will review some of the primary causes of such symptoms and discuss which cases may require a quick trip to the emergency room for potentially lifesaving intervention.

Laryngeal and tracheal (upper airway) and esophageal (upper GI) obstructions: The larynx is the opening from the mouth into the windpipe (trachea). The windpipe travels into the lungs. If this gateway into the windpipe or the windpipe itself is blocked by an object or swelling the pet may not be able to get enough oxygen. In these cases there may be a history of the pet chewing on a bone, treat, ball or toy immediately before the onset of symptoms.

These cases can be very life threatening and may require immediate sedation or anesthesia for removal of an object and to provide oxygen. Pets with these conditions tend to be gagging and hacking constantly with no rest and often times are frothing at the mouth or salivating and their gum color may become purple or blue. In rare cases performing a tracheostomy (surgical opening of the windpipe below the obstruction to allow air into the lungs) or endoscopy (scoping) of the trachea or esophagus to attempt to grasp and remove the obstruction may be required.

These symptoms can also occur if an object blocks the esophagus (tube from the mouth to the stomach). Generally the degree of choking is not as severe as when the airway is blocked, but sometimes objects in the esophagus can compress the trachea/windpipe and cause severe symptoms of choking.

With both airway and esophageal obstructions, the Heimlich maneuver can be attempted. With the head down and the hind limbs up, the sternum (breastbone) or ribcage may be compressed in an attempt to expel the obstruction. This is generally not recommended at home unless it is apparent that the pet cannot breathe and is imminently life threatened.

Laryngeal Paralysis: In large breed, older dogs (and rarely in cats) paralysis of the nerve that is responsible for opening the larynx (gateway to the trachea/windpipe) can occur, which causes narrowing of the glottis (vocal chords and the space between them). This disorder causes poor oxygen flow into the lungs and is associated with exercise intolerance and increased breathing effort with wheezing (stridor) upon inhalation. It is common for dog owners to notice a loss of bark or voice change in their pets. These dogs are prone to overheating and choking on phlegm or vomit because the airway does not seal completely.

Pets with laryngeal paralysis oftentimes require sedation and oxygen therapy until corrective surgery can be performed to allow more complete opening of the airway.

Brachycephalic Syndrome: Brachycephalic (broad head, short nose) dogs include species such as the English Bulldog, Boston Terrier, Pug, Pekingese, Boxer, Lhasa apso, and Shih Tzu. Brachycephalic cats (Persians and Himalayans) can uncommonly require treatment. These breeds can have anatomical malformations of the nostrils (too narrow), soft palpate/roof of mouth (too long), laryngeal saccules (everted and swollen tissue of the larynx), trachea/wind pipe (too narrow), among other airway abnormalities. Upper airway obstruction with choking and poor air flow can be caused by any combination of those abnormalities. In many cases the affected animals may require surgical intervention to remedy anatomical airway abnormalities to provide better exchange of air.

Any brachycephalic animals with symptoms of upper airway blockage, choking, or difficulty breathing should be assessed immediately as these symptoms can become threatening without rapid supportive care.

Tracheal Collapse: Collapse of the windpipe/trachea is a condition that occurs most commonly in toy breed dogs. The Yorkshire Terrier is the most common breed affected. The windpipe is generally rigid, but in these pets it can become weak and collapse on itself due to pressure from inhalation. A harsh cough that worsens with activity or stress and sounds like a “goose honk” is commonly described.

These patients are oftentimes treated with sedation, anti-cough (antitussive) medications, oxygen, and anti-inflammatories to reduce swelling. Stress can create a vicious cycle and worsening of the condition so keeping the pet as calm as possible and getting them into the hospital is recommended.

Kennel cough (infectious tracheobronchitis): Viral and bacterial infections of the upper airways of dogs and cats can cause a harsh hacking, gagging cough. These infections are most commonly acquired at kennels/boarding facilities, pet shops, shelters, dog parks and animal hospitals. Owners often describe the cough as sounding like the pet has something caught in their throat and they are trying to hack it up. Sometimes a small amount of white or clear froth, foam or thick phlegm is produced after coughing and there is confusion as to whether or not this material has been vomited up or coughed up. Symptoms usually occur 3-10 days after exposure to the infectious agents. While kennel cough infections create a harsh “choking” cough, these pets are generally stable and eating and drinking with some rest between coughing episodes.

Kennel cough usually has to run its course because it usually begins as a viral infection, but antibiotics and anti-cough (antitussive) medications can reduce severity and longevity of the symptoms and reduce the potential for pneumonia (lower respiratory infection) in young and old pets.

Reverse sneeze syndrome: The reverse sneeze syndrome is oftentimes described as a “hyperventilation” with an audible inspiratory (inhalation) and expiratory (exhalation) component without a forceful expiratory cough. These pets are often times snorting or wheezing upon inhalation and they appear to be unable to “catch their breath.” While this syndrome is dramatic and appears threatening, it tends to spontaneously resolve within moments with no long term ill effect. Irritation of the nasal passageways or the back of the throat (pharynx) is the usual cause.

These are just some examples of conditions that may cause concern for choking in your pet. While some conditions are not necessarily life threatening and may not constitute a true emergency (such as kennel cough or reverse sneeze syndrome), others may require rapid intervention to stabilize your pet and offer life saving treatments (upper airway obstructions, laryngeal paralysis, brachycephalic syndrome, tracheal collapse). The safest approach is to always utilize our emergency services and have a veterinarian assess your pet if it is having symptoms of choking or difficulty breathing. It is much safer to err on the side of caution with breathing difficulties.

It was a delicious ham. It debuted on Christmas Eve, and although all partook, it survived largely intact. Through the following week, and into the early part of the new year, the family fed upon it. A ham sandwich here, ham on pizza there, but apart from an occasional morsel, there was one family member who was largely excluded from the feast: Muggs, the family bulldog. He watched as the rest of the family consumed ham-based treats, only grudgingly sharing a piece with him. As they ate, he stood watch, ready, should the opportunity present. After the last piece of ham was excised from the bone, the family slipped up. The bone was thrown into an open garbage can. Muggs saw it and knew it was his. From the television room, they heard the can topple over, they ran into the kitchen and saw some garbage strewn on the floor but didn’t notice that the bone was gone.

Two days later, Muggs was definitely off. He had stopped eating and drinking, and now was salivating and vomiting. He was presented to our Mount Pleasant Emergency Clinic, and after a brief exam, an X-ray told the story. It was the ham bone. It was lodged in his esophagus between his heart and stomach. It looked enormous relative to its surroundings, and it definitely was not going anywhere on its own. The owners were suddenly facing a life-and-death situation for Muggs. He cannot live with that thing in there, and the choice of how to remove it, what it will actually take to get it out, and even the prognosis, were not immediately clear. This uncertainty translated to an unusually wide estimate of costs.

The first, and probably best, first step would be an endoscope passed down the esophagus. This would be used to try and push the bone into the stomach, where it can be harmlessly dissolved by gastric acids. An added benefit of this approach is that it allows us to visualize the esophagus and assess the damage that the bone has caused. The problem is that if the scope cannot dislodge the bone, surgery is required, which amounts to an additional expense on top of the endoscopy. Surgery will result in the removal of the bone, but it is an invasive step, and even this step is fraught with risk. We can try and open the stomach and pull the bone into it, but if this fails, we are forced into a riskier surgery in which we have to open the thorax and cut into the esophagus. This is a concern because the esophagus is a sensitive structure, and with poor healing qualities. This means an increased risk of complications. It also means that we are opening the chest and working around the lungs. This requires a temporary chest tube to be placed after surgery. It also means that we have to feed through a stomach tube, for a while, as the esophagus heals. So, it could be as simple as a scope removal, or as complicated as an unsuccessful scope, followed by two different surgical approaches, a chest tube, a feeding tube and hopefully no further problems, but you can’t even be sure of that. Depending on the degree of damage the bone has caused, this case could deteriorate rapidly, or be plagued with long-term esophageal problems.

In Muggs’ case, we decided to forego the scope in favor of a direct surgical approach. The stomach was opened and I reached a finger up the esophagus to the bone. I applied a clamp to it and applied traction, but it soon became clear, the bone was lodged so tightly, it could not be pulled out intact. A bone cutting instrument was deployed blindly. Using touch alone, the blades were directed through the stomach, up the esophagus and onto the bone. Luck prevailed, and the bone was sectioned without damaging the esophagus The bone was removed completely in pieces. Muggs was lucky, but many dogs are not. Some owners choose not to pursue treatment due to expense, and sometimes the damage is so severe that even aggressive treatment is not enough to save them.

The message is that it is not OK to allow dogs to have access to a bone they can swallow. I (Dr. Henri Bianucci) hear people say, “I’ve always given my dog bones and have never had a problem.” It’s like saying you have driven without seat belts and never had a problem. The only difference is that it is your dog’s life you are risking.

We have been battling cancer in pets for more than 30 years, and for much of this time we have looked toward human cancer therapies for guidance on how to treat and which medications may be best. For decades, people have been investigating cancer therapy and new drugs using laboratory animals such as mice and rats. No one likes to think of any animal being injected with cancer and then further injected with experimental medications only to eventually die or be killed to determine the results of a study. This sounds inhumane and brutal, but has been one of many research approaches for years. We have learned an infinite amount about cancer behavior and therapy from these “ethically challenging” studies. We cannot ignore the benefits of these studies but we can look forward to try and find a more humane and clinically relevant approach.

While mice and rats are similar to people, the cancers that they develop are experimentally induced by the researcher. In other words the cancers are not spontaneous. The cancer cells are derived from cell lines kept in a laboratory, and they do not always behave in the same manner that spontaneous cancers behave in people. Additionally, in order to get the cancers to grow, the animals have been genetically altered to have a reduced immune system which makes these animals even less like the average person with cancer. How can we take a step away from these rodent model experiments and find a better model for human cancer?

The answer is right in front of me every day. Dogs and cats get the same variety of spontaneous cancers that people will get, and we already know so much about them. Our approach in veterinary medicine and human medicine is changing. As the world connects with social media and the internet and research can be right at everyone’s fingertips, we are beginning to realize that instead of working separately toward the same goal of cancer therapy, we should work together. We are becoming One Medicine. Around the world we are working together to solve complicated questions about cancer therapy. For example, since a dog’s average life span is 10 to 12 years, we can learn much more about their response to cancer therapy in just a few years than what we can learn in people. A study that may take 20 years in people can be done in just 5 years in our pets. We can learn more in less time!

Please understand, I am not advocating making our pets laboratory subjects or victims of harmful research. That would be against my veterinary oath and all that I believe in for our beloved pets. However, when I see a pet with cancer and know that I cannot cure them with any current medical therapy, I would love to have the chance to try a new medication that could give us some hope and help us learn more for people as well. Clinical trials in veterinary medicine are being performed at hospitals and Universities across the world with the hope of advancing not only our care for pets but also people. To find out more about these research trials you can visit the following website:

All clinical trials are strictly regulated for the safe and humane treatment of our pets. We take this responsibility seriously. Trust that if you wish to consider a clinical trial for your pet, they will be treated like royalty. Not only will they be helping further our veterinary understanding of cancer but they may just help save countless lives in the future.

Meet General – Male Mascot for The Citadel!
General presented to VEC early Thursday morning for acute onset shaking and not acting himself. He really was not feeling well, therefore Boo (his wife and co-mascot) accompanied him.
He was diagnosed with a yeast infection in both of his ears and a corneal ulcer of his left eye.
Dr. Fetterolf noticed a cloudy appearance to a portion of his cornea upon presentation. Then she used a special fluorescent stain to confirm the presence of the ulcer or erosion. Normally, water will run smoothly off the surface of the cornea, like rain washing off a windshield. If the cornea is damaged, the stain will stick to the damaged area and show bright green.
General was treated to a thorough cleansing of his ears while here. And he was send home with oral pain medication, antibiotic eye drops, and anti-yeast ear drops.
We hope he is feeling better very soon! It was a please to work with such a celebrity!

FYI:
Common causes of corneal erosions include:
• Rough contact with plants, thorns, or bushes
• Scratches from another animal (note: the cat scratch wound can be especially serious as the wound quickly heals over, sealing infection within the eye.)
• Self trauma (rubbing or scratching at a painful ear or even at the eye due to some other eye problem can lead to an inadvertent scratch to the eye.)
• Chemical irritation (such as getting shampoo in the eye during a bath.)
• Foreign body injury (plant material can get stuck under an eyelid and can scrape the cornea.)

Gallbladder surgery
Bile is a yellow fluid that is made in the liver and helps in the digestion of fats. Bile drains from the liver through ducts into the gallbladder. In the gallbladder the bile is concentrated and stored. The gallbladder contracts and releases bile into ducts that drain into the intestine when a meal has been ingested.
It is common for dogs to develop problems with the gallbladder that require surgical intervention. Most commonly we see dogs develop mucous accumulation in the gallbladder (called a gallbladder mucocele) A mucocele can cause obstruction of the duct draining the gallbladder and eventually cause rupture of the gallbladder wall. Dogs and cats can develop gall stones, but they usually only cause a problem if there is infection associated with the stones, or one of the stones blocks the duct that drains the gallbladder. The gallbladder can also rupture from blunt or penetrating trauma. It is rare to see cancer of the gallbladder in small animals.
Animals with gallbladder disease often present with mild signs of lethargy, decreased appetite and/or vomiting. In cases of prolonged obstruction or trauma, they can become very sick and present to the hospital in shock. Blood tests are helpful to determine if the gallbladder is obstructed and an abdominal ultrasound is accurate at diagnosing gallbladder disease and determining the need for surgery. Early treatment of gallbladder disease results in the best prognosis.
Surgical treatment of gallbladder disease usually involves removal of the gallbladder. Dogs and cats can live normal lives without a gallbladder as long as the ducts draining bile from the liver are not obstructed. If the ducts are blocked, a biliary rerouting surgery needs to be done. This involves making a hole in the gallbladder and sewing it to a hole made in the intestine so bile can flow directly from the gallbladder into the intestine.
The recovery after surgery depends on the underlying disease and the health of the patient prior to surgery. Dogs and cats that are not very sick prior to surgery can often go home the next day. If the gallbladder is ruptured and there is severe infection, the prognosis for recovery is only about 50%.

Sam is a very sweet and friendly 11 year old male/neutered Yorkhire Terrier. He saw his regular veterinarian earlier this week for acute onset vomiting and anorexia. His owner also noted a several week history of polyuria & polydypsia (pu/pd – increased urination / increased thirst). He was diagnosed with diabetes mellitus and diabetes ketoacidosis (DKA). He was transferred to Veterinary Emergency Care for additional work-up and care. Abdominal ultrasound revealed severe Pancreatitis, secondary to the DKA. Sam has been with us for several days now; he has been on IV fluids, injectable medications, and has received a Fresh Frozen Plasma (FFP) transfusion. We are happy to report that he has been responding very well to treatment and is on his way to recovery.
To learn more about canine / feline diabetes mellitus, diabetes ketoacidosis, and pancreatitis, please see the following website: www.veterinarypartner.com

Bowel (or gastrointestinal) obstructions are one of the most common causes of vomiting and decreased appetite in dogs and cats. By far the frequent cause of this is foreign body ingestion. Dogs and cats love to c…hew on and eat everything they come in contact with. While their stomach is capable of digesting and breaking down a lot of items, certain materials cannot pass through and ultimate get stuck leading to an obstruction or blockage. Common foreign bodies include socks, underwear, t-shirts, rope toys, any type of string in cats, rocks, leashes, trash, etc. Once obstructed patients tend to vomit, especially right after eating, become lethargic or weak, not be interested in food or water and ultimately act like they feel bad. Typically the key diagnosis of a GI obstruction is made from x-rays. While most foreign material cannot be seen on an x-ray there are characteristic signs that make a veterinarian suspicious for a GI obstruction. More challenging cases can require a barium series or abdominal ultrasound to make a diagnosis. Some animals can naturally pass foreign material on their own but unfortunately the vast majority require either endoscopy (removal via a camera placed into the stomach) or surgical removal. GI obstructions caused by foreign body ingestion are normally considered emergencies as with time the intestine can be damaged and leak, leading to a life threatening condition (peritonitis). Surgery usually involves opening the stomach or a portion of the intestine to extract the foreign material, however in extreme cases can even involve removing a portion of damaged intestine. Most animals are usually discharged within a day or two following surgery and are back to normal in a short period of time. Unfortunately they do not usually learn any lesson and ‘repeat’ offenders are common. Ways to prevent foreign body ingestion is to choose toys carefully (look for toys that cannot be destroyed), avoid leaving laundry loose around the house and immediately remove anything you find your pet chewing on. While a GI obstruction caused by a foreign body is not the only reason dogs and cats vomit any time your pet is sick we recommend having them evaluated by a veterinarian. – Dr. Mike Schlicksup, Board Certified Surgeon